Insertion instrument with articulating wrist

ABSTRACT

A surgical instrument suitable for preparing an intervertebral disc space includes an outer sleeve, an instrument head, an inner shaft, a handle, a universal joint, a coupling member, and a drive mechanism. The outer sleeve includes a proximal end, a distal end and a longitudinal axis. The instrument head defines a longitudinal axis and is disposed at the distal end of the outer shaft. The inner shaft is slidably disposed within the outer sleeve and includes a proximal end, a distal end and a longitudinal axis coaxially aligned with the longitudinal axis of the outer sleeve. The drive mechanism is coupled between the outer sleeve and the inner shaft and actuates the outer sleeve axially relative to the inner shaft, thereby setting an angle of the longitudinal axis of the instrument head in relation to the longitudinal axis of the inner shaft.

CROSS REFERENCE TO RELATED APPLICATION

The present application is a continuation of U.S. patent applicationSer. No. 14/676,046, filed Apr. 1, 2015 entitled “INSERTION INSTRUMENTWITH ARTICULATING WRIST”, now

U.S. Pat. No. 10,265,194, which is incorporated herein by this referencein its entirety.

FIELD

The present disclosure relates to a surgical instrument, and moreparticularly to a surgical insertion instrument having an articulatingwrist.

BACKGROUND

This section provides background information related to the presentdisclosure and is not necessarily prior art.

Instruments and tools are used during surgical procedures for variouspurposes, including providing access to a surgical site, inserting orproviding materials to the surgical site, and attaching or otherwiseassembling certain components at the surgical site. In some situations,it may be necessary or desirable to insert the surgical instrument intosmall or constrained space, or enter the surgical site from apredetermined direction, or access a predetermined location in thesurgical site, or provide a portion of the surgical instrument withvarious manners of movement (e.g., translation, rotation, angulation,etc.) at the surgical site. For example, during some surgical proceduresit may be desirable to access or otherwise approach the surgical sitefrom a lateral direction in order to avoid a portion of the anatomy orto enter another portion of the anatomy.

While known surgical instruments have proven to be acceptable for theirintended purposes, a continuous need for improvement in the relevant artremains. In this regard, it would be desirable to provide a surgicalinstrument that allows, or otherwise makes it easier, for a surgeon toaccess the surgical site and/or use and manipulate the surgicalinstrument at the surgical site.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

According to one aspect of the present disclosure, a surgical instrumentsuitable for preparing an intervertebral disc space is provided. Thesurgical instrument includes an outer sleeve, an instrument head, aninner shaft, a handle, a universal joint, a coupling member, and a drivemechanism. The outer sleeve includes a proximal end, a distal end and alongitudinal axis. The instrument head defines a longitudinal axis andis disposed at the distal end of the outer shaft. The inner shaft isslidably disposed within the outer sleeve and includes a proximal end, adistal end and a longitudinal axis coaxially aligned with thelongitudinal axis of the outer sleeve. The handle is coupled to theproximal end of the inner shaft. The universal joint includes one endcoupled to the distal end of the inner shaft and another end coupled tothe instrument head. The coupling member includes one end pivotablycoupled between the distal end of the outer sleeve and another endpivotably coupled to a retainer. The drive mechanism is coupled betweenthe outer sleeve and the inner shaft and actuates the outer sleeveaxially relative to the inner shaft, thereby setting an angle of thelongitudinal axis of the instrument head in relation to the longitudinalaxis of the inner shaft.

In some configurations, the instrument head includes one of a hexagonalhead, a screw driver, and a drill bit.

In some configurations, the universal joint includes an annular grooveand the retainer includes an aperture. The surgical instrument furtherincludes a hinge member disposed within the aperture and the annulargroove.

In some configurations, the drive mechanism includes a first drivemechanism coupled to the inner shaft and a second drive mechanismcoupled to the outer shaft.

In some configurations, the surgical instrument includes a handlemember.

In some configurations, the first drive mechanism is rotatable inrelation to the handle member and the second drive mechanism, and thesecond drive mechanism is rotatable in relation to the handle member andthe first drive mechanism.

In some configurations, the outer sleeve includes a first threadedportion and the second drive mechanism includes a second threadedportion threadingly engaged with the first threaded portion.

In some configurations, the outer sleeve includes a retaining featureextending from a proximal end to a distal end along the longitudinalaxis.

In some configurations, a portion of the handle assembly slidablyengages the retaining feature.

According to another aspect of the present disclosure, a surgicalinstrument is provided. The surgical instrument includes an outersleeve, an inner shaft, a universal joint, a retainer, and a coupler.The outer sleeve includes a proximal end, a distal end, and alongitudinal axis extending between the proximal and distal ends. Theinner shaft is rotatably and translatably disposed within the outersleeve. The universal joint is pivotally coupled to the inner shaft. Theretainer is configured to rotatably support the universal joint. Thecoupler includes a proximal end pivotally coupled to the outer sleeveand a distal end pivotally coupled to the retainer.

According to yet another aspect of the present disclosure, a method ofoperating a surgical instrument is provided. The surgical instrumentincludes an outer sleeve extending along a first axis, an inner shaftsupported by the outer sleeve for rotation about the first axis, and adrive member extending along a second axis. The method includes rotatingthe inner shaft about the first axis to rotate the drive member aboutthe second axis. The method also includes translating the outer sleevealong the first axis to angulate the second axis relative to the firstaxis.

In some configurations, the surgical instrument includes an activationmember threadably engaged to the outer sleeve.

In some configurations, translating the outer sleeve along the firstaxis includes threading the activation member relative to the outersleeve.

In some configurations, the surgical instrument includes an implantcoupled to at least one of the inner shaft and the outer sleeve, and themethod includes inserting the surgical instrument through an incision inan anterior posterior direction. The method can also include insertingthe implant into an intervertebral disc space in a medial lateraldirection.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1A is a perspective view of an insertion instrument with anarticulating wrist in a first position in accordance with the principlesof the present disclosure;

FIG. 1B is a perspective view of the insertion instrument with anarticulating wrist of FIG. 1, the insertion instrument shown in a secondposition;

FIG. 2 is an exploded view of the insertion instrument with anarticulating wrist of FIG. 1;

FIG. 3 is a cross-sectional view of a portion of the insertioninstrument with an articulating wrist of FIG. 1 taken along the line3-3;

FIG. 4 is a cross-sectional view of a portion of the insertioninstrument with an articulating wrist of FIG. 1 taken along the line 4-4

FIG. 5 is a perspective view of a portion of the insertion instrumentwith an articulating wrist of FIG. 1, with a portion of the insertioninstrument removed for clarity;

FIG. 6 is a cross-sectional view of a portion of the insertioninstrument with an articulating wrist of FIG. 1 taken along the line3-3.

FIG. 7A is an environmental view of the insertion instrument with anarticulating wrist of FIG. 1 in a first mode of operation; and

FIG. 7B is an environmental view of the insertion instrument with anarticulating wrist of FIG. 1 in a second mode of operation.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

Referring to FIG. 1A, an insertion instrument 10 with an articulatingwrist constructed in accordance with the principles of the presentteachings is illustrated. According to one exemplary use, the insertioninstrument 10 may be used to insert an implant during a surgicalprocedure. Specifically, in some configurations, the insertioninstrument 10 may be used to insert a spinal implant 12 into a portionof a spine 14 (FIGS. 7A and 7B), including into an intervertebral space15 between adjacent vertebrae 17. It will be appreciated, however, thatthe insertion instrument 10 may have various uses within the scope ofthe present disclosure. For example, as will be discussed in more detailbelow, the insertion instrument 10 may be used for drilling or otherwiseforming an aperture, driving a fastener, assembling a multi-componentimplant, or other similar uses.

With particular reference to FIGS. 1A, 1B and 6, the insertioninstrument 10 includes an articulation assembly 16 and a handle assembly18. As will be explained in more detail below, the articulation assembly16 may be drivingly engaged with the handle assembly, such thatmanipulation (e.g., rotation) of a portion of the handle assembly 18 cancause a portion of the articulation assembly 16, and thus the implant12, to move (e.g., rotate, translate, angulate, etc.).

As illustrated in FIG. 2, the articulation assembly 16 can include anouter sleeve 20, an inner sleeve or shaft 22, a universal joint 24, acoupler 26, and a retainer 28. The outer sleeve 20 includes, orotherwise extends from and between a proximal end 30 and a distal end 32along a first longitudinal axis A1. In this regard, as illustrated inFIGS. 3 and 6, the outer sleeve 20 includes a bore 34 extendinglongitudinally from and between the proximal and distal ends 30, 32 ofthe outer sleeve 20. The proximal end 30 of the outer sleeve 20 caninclude a threaded portion 36 and an anti-rotation feature 38. Asillustrated in FIGS. 2 and 6, the threaded portion 36 can be an outerthreaded portion 36. The anti-rotation feature 38 can include a channelor groove formed in an outer surface 42 of the outer sleeve 20 betweenthe proximal end 30 and the threaded portion 36. In this regard, theanti-rotation feature 38 can extend from a proximal end 44 to a distalend 46 along the first longitudinal axis A1. As will be explained inmore detail below, the distance along the first longitudinal axis A1,between the proximal end 44 and the distal end 46 of the anti-rotationfeature 38, can define a maximum travel distance of the outer sleeve 20relative to the inner shaft 22 along the first longitudinal axis A1.

As illustrated in FIG. 2, the distal end 32 of the outer sleeve 20 caninclude a first pivot feature or hinge 50. The hinge 50 can be anaperture formed in the outer sleeve 20, and a pin member 52. As will beexplained in more detail below, in an assembled configuration, the hinge50 can pivotally couple the outer sleeve 20 to the coupler 26. Asillustrated, the distal end 32 of the outer sleeve 20 can also include acut-away or recessed portion 51, such that the distal end 32 of theouter sleeve 20 defines a portion of a cylinder (e.g., asemi-cylindrical construct).

With further reference to FIG. 2, the shaft 22 includes, or otherwiseextends from and between a proximal end 53 and a distal end 54 along asecond longitudinal axis A2. In an assembled configuration, the shaft 22can be rotatably and translatably disposed within the bore 34 of theouter sleeve 20, such that the second longitudinal axis A2 is parallelto the first longitudinal axis A1. In this regard, the shaft 22 isconfigured to rotate within the outer sleeve 20 about the secondlongitudinal axis A2, and translate within the outer sleeve 20 along thesecond longitudinal axis A2.

The shaft 22 can include a first retaining feature or groove 56 disposednear the proximal end 53, a hinge mechanism or yoke 58 disposed near thedistal end 54, and a retaining feature or reduced diameter portion 60disposed between the proximal and distal ends 53, 54. As will beexplained in more detail, below, in the assembled configuration thegroove 56 can secure the shaft 22 to the handle assembly 18, and thehinge mechanism 58 can be pivotally coupled to the universal joint 24.In this regard, the hinge mechanism 58 can define a first pivot axis P1of the universal joint 24. As will be explained in more detail below,the reduced diameter portion 60 can help to secure the shaft 22 withinthe outer sleeve 20, and/or further define the maximum travel distanceof the outer sleeve 20 relative to the inner sleeve 22 along the firstlongitudinal axis A1. In this regard, with reference to FIGS. 3 and 4,the pin 52 can create or otherwise define a reduced diameter portion ofthe bore 34 of the outer sleeve 20 that is substantially equal to, orslightly greater than, an outer diameter of the reduced diameter portion60 of the shaft 22. Accordingly, the shaft 22 is at least partiallysupported for rotation and translation by the pin 52.

As illustrated in FIG. 2, the universal joint 24 can include a spider orcross-piece 64 and a hinge mechanism or yoke 66. The hinge mechanism 66can define a second pivot axis P2 of the universal joint 24. The secondpivot axis P2 is perpendicular to the first pivot axis P1. In thisregard, in the assembled configuration, the hinge mechanism 58 of theshaft 22 can be pivotally coupled to the cross-piece 64 for pivotalrotation about the first pivot axis P1, and the hinge mechanism 66 ofthe universal joint 24 can be pivotally coupled to the cross-piece 64for pivotal rotation about the second pivot axis P2.

With reference to FIGS. 2 and 3, the hinge mechanism 66 may furtherinclude an instrument head or driving feature 70 and a retaining feature72. The driving feature 70 and the second pivot axis P2 may be disposedat opposite ends of the hinge mechanism 66. As illustrated in FIG. 2,the driving feature 70 can include a hex head or other similar featurethat can drivingly engage, or otherwise mate with, the implant 12. Inthis regard, it will also be appreciated that the driving feature 70 mayinclude, or otherwise be configured to mate with, other surgical toolsor implants, such as drill bits, fasteners, pins, and other similarcomponents. The retaining feature 72 can be disposed between the secondpivot axis P2 and the driving feature 70. As illustrated in at leastFIG. 2, in some configurations, the retaining feature 72 can include anannular groove or channel. As will be explained in more detail below, inthe assembled configuration, the retaining feature 72 can help torotatably secure the hinge mechanism 66 within the retainer 28.

The coupler 26 can extend from a proximal end 78 to a distal end 80. Insome configurations, the coupler 26 may include or otherwise define aportion of a cylinder extending from and between the proximal and distalends 78, 80. In this regard, in the assembled configuration, the coupler26 may mate with, or otherwise be received by, the recessed portion 51of the outer sleeve, such that the distal end 32 of the outer sleeve 20and the coupler 26 collectively define a substantially cylindricalconstruct.

The proximal end 78 of the coupler 26 includes a first pivot or hingefeature 82, and the distal end 80 includes a second pivot or hingefeature 84. As illustrated in FIG. 2, in some configurations, the firstand second hinge features 82, 84 can each include a pair of alignedapertures. In the assembled configuration, the first hinge feature 82can be pivotally coupled to the outer sleeve 20, and the second hingefeature 84 can be pivotally coupled to the retainer 28. In this regard,in the assembled configuration, the pin 52 can be rotatably received byat least one of the first hinge feature 82 and the hinge 50 of the outersleeve 20, such that the coupler 26 is pivotally coupled to the outersleeve 20, as described above.

The retainer 28 includes, or otherwise extends from and between aproximal end 88 and a distal end 90 along a third longitudinal axis A3.In this regard, as illustrated in FIG. 3, the retainer 28 includes abore 92 extending longitudinally from and between the proximal anddistal ends 88, 90. The bore 92 is sized and shaped to receive a portionof the hinge mechanism 66 (e.g., the driving feature 70) for rotationtherein. The proximal end 88 of the retainer 28 can include a secondpivot feature or hinge 94 that is substantially similar to the firstpivot feature or hinge 50 formed in the outer sleeve 20. In this regard,the hinge 94 can include an aperture formed in the retainer 28, and apin 98. As illustrated in FIG. 3, the pin 98 and the pin 52 may defineparallel pivot axes P3, P4, respectively. In the assembledconfiguration, the pin 98 can be rotatably received by at least one ofthe second hinge feature 84 of the coupler 26 and the hinge 94 of theretainer 28, such that the retainer 28 is pivotally coupled to thecoupler 26. In this regard, as illustrated in FIG. 3, the pin 98 can bereceived within the retaining feature 72 of the hinge mechanism 66, suchthat the pin 98 can allow the hinge mechanism 66 to rotate within thebore 92 about the third longitudinal axis A3, and can prevent the hingemechanism 66 from translating within the bore 92 in a direction parallelto the third longitudinal axis A3. In this regard, as illustrated inFIG. 4, in the assembled configuration, the pin 98 can be slidablyreceived within the groove 72.

As illustrated in FIG. 2, the proximal end 88 of the retainer 28 canalso include a cut-away or recessed portion 100, such that the proximalend 88 of the retainer 28 defines a portion of a cylinder (e.g., asemi-cylindrical construct). In this regard, in the assembledconfiguration, the coupler 26 may mate with, or otherwise be receivedby, the recessed portion 100 of the retainer 28, such that the coupler26 and the proximal end 88 of the retainer 28 collectively define asubstantially cylindrical construct.

With reference to FIGS. 1, 2 and 6, the handle assembly 18 includes ahandle 104, a first drive or actuation mechanism 106, and a second driveor actuation mechanism 108. As will be explained in more detail below,the first and second actuation mechanisms 106, 108 can be rotatablycoupled to the handle 104 and configured to drive or actuate the shaft22 and the outer sleeve 20, respectively, and cause the hinge mechanism66 to rotate about the third longitudinal axis A3, and/or to cause thehinge mechanism 66 and third longitudinal axis A3 to angulate relativeto the first longitudinal axis A1.

The handle 104 includes, or otherwise extends from and between aproximal end 112 and a distal end 114 along a fourth longitudinal axisA4. In this regard, as illustrated in FIG. 6 the handle 104 includes abore 116 extending longitudinally from and between the proximal anddistal ends 112, 114 of the handle 104. The bore 116 can be sized andshaped to rotatably receive the outer sleeve 20, the inner shaft 22, andthe first and second actuation mechanisms 106, 108 at the proximal anddistal ends 112, 114, respectively, of the handle 104.

As illustrated in FIG. 6, the first actuation mechanism 106 is coupledto the shaft 22 and rotatably received within the bore 116 of the handle104. In this regard, in the assembled configuration the shaft 22 may becoupled to the first actuation mechanism 106 with a set screw 118, forexample, such that rotation of the first actuation mechanism 106 causesthe rotation of the shaft 22 about the second longitudinal axis A2, andin turn, rotation of the hinge mechanism 66 and the drive feature 70about the third longitudinal axis A3.

With continued reference to FIG. 6, the second actuation mechanism 108is coupled to the outer sleeve 20 and rotatably received within the bore116 of the handle 104. In this regard, the second actuation mechanism108 may include an internally threaded portion 122 configured to engagethe threaded portion 36 of the outer sleeve 20. Accordingly, and as willbe explained in more detail below, in the assembled configuration,rotation of the second actuation mechanism 108 relative to the handle104 can cause the threaded portion 122 of the second actuation mechanism108 to threadably engage the threaded portion 36 of the outer sleeve,and in turn, cause the outer sleeve 20 to translate within the bore 116and along the first longitudinal axis A1.

With continued reference to the figures, operation of the insertioninstrument 10 will now be described in more detail. In a first mode ofoperation, a surgeon may choose to rotate the driving feature 70, or theimplant 12 coupled thereto, for example, about the third longitudinalaxis A3. In this regard, in the first mode of operation, the surgeon mayrotate the first actuation mechanism 106 relative to the handle 104about the fourth longitudinal axis A4, to cause the shaft 22 and thedriving feature 70, coupled thereto in the manner described above, torotate about the second and third longitudinal axes A2, A3,respectively. Accordingly, the driving feature 70 and/or the implant 12may rotate from a first position (FIG. 1A) to a second position (FIG.1B) about the third longitudinal axis A3.

With reference to FIGS. 7A and 7B, in an exemplary surgical procedure,the first mode of operation may include creating an incision 102 in apatient to provide access to a surgical site 104 from a first direction.For example, the incision 102 may be aligned with the patient's spine14, and provide access to the patient's spine 14 from ananterior-posterior direction. Accordingly, the implant 12 may beinserted into the incision in the anterior-posterior direction while theinstrument 10 is in the first position (FIG. 7A).

In a second mode of operation, the surgeon may choose to angulate thethird longitudinal axis A3 or the driving feature 70 relative to thesecond longitudinal axis A2 of the shaft 22. The second mode ofoperation can occur before, after, or concurrently with the first modeof operation. Specifically, the surgeon may rotate the second actuationmechanism 108 relative to the handle 104 about the fourth longitudinalaxis A4. As the surgeon rotates the second actuation mechanism 108, thethreaded portion 122 of the second actuation mechanism 108 willthreadably engage the threaded portion 36 of the outer sleeve 20. Inthis regard, the handle assembly 18 may further include at least onesecond anti-rotation feature or pin 126. In the assembled configuration,the pin 126 will engage the anti-rotation feature 38 formed in the outersleeve 20 to prevent the outer sleeve from rotating relative to thehandle 104. As the outer sleeve 20 threadably engages the secondactuation mechanism 108, the outer sleeve will translate relative to thehandle 104, and thus the shaft 22, along the first longitudinal axis A1.As the outer sleeve 20 translates along the first longitudinal axis A1,the coupler 26 will restrain the distance between the hinge 94 of theretainer 28 and the hinge 50 of the outer sleeve 20, while the pin 98and the retaining feature 72 of the hinge mechanism 66 can prevent theretainer 28 from translating relative to the hinge mechanism 66 alongthe third longitudinal axis A3. Accordingly, as the outer sleeve 20translates along the first longitudinal axis A1, the hinge mechanism 66is forced to pivot about the first and/or second pivot axes P1, P2, thusallowing the third longitudinal axis A3 to angulate relative to thefirst longitudinal axis A1 from the first position (FIG. 7A) to thesecond position (FIG. 7B). As illustrated in FIGS. 7A and 7B, the firstlongitudinal axis A1 may remain in the same position in both the firstand second modes of operation.

In an exemplary surgical procedure, the second mode of operation mayinclude directing or otherwise moving the driving feature 70 and/or theimplant 12 in a second direction transverse to the first direction. Forexample, as illustrated in FIGS. 7A and 7B, in a spinal surgeryprocedure, the surgeon may direct the driving feature 70 and/or theimplant 12 into the surgical site 104, such as the intervertebral discspace 15 of the spine 14 for example, in a medial-lateral direction,while a portion of the instrument 10 extends through the incision 102 inthe anterior-posterior direction. Accordingly, as illustrated in FIG.7B, the implant 12 may be inserted into the intervertebral disc space 15while the outer sleeve 20 remains in the first position (FIG. 7A).

The adjustability (e.g., rotation) of the driving feature 70 about thethird longitudinal axis A3, and the adjustability of the thirdlongitudinal axis (e.g., angulation) relative to the first longitudinalaxis A1 can allow the surgeon to move the driving feature 70 and/or theimplant 12 into a plurality of positions. As such, the adjustability ofthe driving feature 70 and/or the implant 12 can allow the surgeon toaccess the surgical site 104 from various directions and in variousconfigurations to perform a variety of procedures at the surgical site104.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

Example embodiments are provided so that this disclosure will bethorough, and will fully convey the scope to those who are skilled inthe art. Numerous specific details are set forth such as examples ofspecific components, devices, and methods, to provide a thoroughunderstanding of embodiments of the present disclosure. It will beapparent to those skilled in the art that specific details need not beemployed, that example embodiments may be embodied in many differentforms and that neither should be construed to limit the scope of thedisclosure. In some example embodiments, well-known processes,well-known device structures, and well-known technologies are notdescribed in detail.

The terminology used herein is for the purpose of describing particularexample embodiments only and is not intended to be limiting. As usedherein, the singular forms “a,” “an,” and “the” may be intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. The terms “comprises,” “comprising,” “including,” and“having,” are inclusive and therefore specify the presence of statedfeatures, integers, steps, operations, elements, and/or components, butdo not preclude the presence or addition of one or more other features,integers, steps, operations, elements, components, and/or groupsthereof. The method steps, processes, and operations described hereinare not to be construed as necessarily requiring their performance inthe particular order discussed or illustrated, unless specificallyidentified as an order of performance. It is also to be understood thatadditional or alternative steps may be employed.

When an element or layer is referred to as being “on,” “engaged to,”“connected to,” or “coupled to” another element or layer, it may bedirectly on, engaged, connected or coupled to the other element orlayer, or intervening elements or layers may be present. In contrast,when an element is referred to as being “directly on,” “directly engagedto,” “directly connected to,” or “directly coupled to” another elementor layer, there may be no intervening elements or layers present. Otherwords used to describe the relationship between elements should beinterpreted in a like fashion (e.g., “between” versus “directlybetween,” “adjacent” versus “directly adjacent,” etc.). As used herein,the term “and/or” includes any and all combinations of one or more ofthe associated listed items.

Although the terms first, second, third, etc. may be used herein todescribe various elements, components, regions, layers and/or sections,these elements, components, regions, layers and/or sections should notbe limited by these terms. These terms may be only used to distinguishone element, component, region, layer or section from another region,layer or section. Terms such as “first,” “second,” and other numericalterms when used herein do not imply a sequence or order unless clearlyindicated by the context. Thus, a first element, component, region,layer or section discussed below could be termed a second element,component, region, layer or section without departing from the teachingsof the example embodiments.

Spatially relative terms, such as “inner,” “outer,” “beneath,” “below,”“lower,” “above,” “upper,” and the like, may be used herein for ease ofdescription to describe one element or feature's relationship to anotherelement(s) or feature(s) as illustrated in the figures. Spatiallyrelative terms may be intended to encompass different orientations ofthe device in use or operation in addition to the orientation depictedin the figures. For example, if the device in the figures is turnedover, elements described as “below” or “beneath” other elements orfeatures would then be oriented “above” the other elements or features.Thus, the example term “below” can encompass both an orientation ofabove and below. The device may be otherwise oriented (rotated 90degrees or at other orientations) and the spatially relative descriptorsused herein interpreted accordingly.

What is claimed is:
 1. A method of operating a surgical instrumentincluding an outer sleeve extending along a first axis, an inner shaftsupported by the outer sleeve rotatable about the first axis, a drivemember extending along a second axis, and a coupling member pivotablyconnected to the outer sleeve and a retainer containing the drivemember, the method comprising: rotating the inner shaft about the firstaxis to rotate the drive member about the second axis; and translatingthe outer sleeve along the first axis causing the coupling member topivot about first and second pivot points to angulate the second axisrelative to the first axis, wherein the translating the outer sleevecauses the first pivot point to translate relative to the inner shaftand concurrently causes a retaining feature in the drive member toprevent linear translation of the second pivot point relative to thedrive member, wherein the translating the outer sleeve includes a pinforming the second pivot point interacting with the retaining feature inthe form of an annular groove to prevent linear translation of thesecond pivot point relative to the drive member.
 2. The method of claim1, wherein the surgical instrument includes an activation memberthreadably engaged to the outer sleeve, and wherein the translating theouter sleeve along the first axis includes threading the activationmember relative to the outer sleeve.
 3. The method of claim 1, whereinthe surgical instrument includes an implant coupled to at least one ofthe inner shaft and the outer sleeve, the method further comprising:inserting the surgical instrument through an incision in an anteriorposterior direction; and articulating the implant into an intervertebraldisc space in a medial lateral direction.
 4. The method of claim 3,wherein the articulating the implant is caused by the translating theouter sleeve.
 5. The method of claim 3, further comprising rotating afirst actuation mechanism disposed on a proximal end of a handleassembly coupled to the inner shaft to release the implant within theintervertebral disc space.
 6. The method of claim 5, wherein thetranslating the outer sleeve includes rotating a second actuationmechanism disposed on a distal end of the handle assembly.
 7. The methodof claim 1, wherein the translating the outer sleeve includes causingthe coupling member to restrain a distance between a first hinge on theouter sleeve and a second hinge on the retainer.
 8. The method of claim1, wherein the translating the outer sleeve includes linearly shiftingthe outer sleeve along the first axis relative to at least a portion ofthe inner shaft.
 9. A method comprising: rotating an inner shaftextending along a first axis of a surgical instrument and containedwithin an outer sleeve to rotate an implant attached to a drive memberaround a second axis, the drive member contained within a retainer andcoupled to the inner shaft through a universal joint; and translatingthe outer sleeve along the first axis causing a coupling memberpivotably coupled to the outer sleeve by a first pivot point and theretainer by a second pivot point to angulate the second axis relative tothe first axis, wherein the translating the outer sleeve causes thefirst pivot point to translate relative to the inner shaft andconcurrently a retaining feature on the drive member prevents lineartranslation of the second pivot point relative to the drive member,wherein the translating the outer sleeve includes a pin forming thesecond pivot point interacting with the retaining feature in the form ofan annular groove to prevent linear translation of the second pivotpoint relative to the drive member.
 10. The method of claim 9, whereinthe surgical instrument includes an activation member threadably engagedto the outer sleeve, and wherein the translating the outer sleeve alongthe first axis includes threading the activation member relative to theouter sleeve.
 11. The method of claim 9, further comprising: insertingthe surgical instrument through an incision in an anterior posteriordirection; and articulating the implant into an intervertebral discspace in a medial lateral direction.
 12. The method of claim 11, whereinthe articulating the implant is caused by the translating the outersleeve.
 13. The method of claim 11, further comprising rotating a firstactuation mechanism disposed on a proximal end of a handle assemblycoupled to the inner shaft to release the implant within theintervertebral disc space.
 14. The method of claim 13, wherein thetranslating the outer sleeve includes rotating a second actuationmechanism disposed on a distal end of the handle assembly.
 15. Themethod of claim 9, wherein the translating the outer sleeve includescausing the coupling member to restrain a distance between a first hingeon the outer sleeve and a second hinge on the retainer.
 16. The methodof claim 9, wherein the translating the outer sleeve includes linearlyshifting the outer sleeve along the first axis relative to at least aportion of the inner shaft.